Status:
Ready to upload
Record number:
1786
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for melanoma (Council of Europe, 2018): donors with active melanoma represent an unacceptable risk for organ donation. Donors with a history of treated melanoma are generally considered to represent a high transmission risk. Opinions vary. The SaBTO/UK states that a superficial spreading melanoma with tumor thickness less than 1.5 mm and with curative surgery and cancer free interval of more than five years is associated with a low transmission risk, although this conclusion is based on a small number of cases. UNOS/DTAC considers all patients with a history of melanoma to represent a high risk for transmission.
Time to detection:
1 year
Alerting signals, symptoms, evidence of occurrence:
Presented to emergency department with abdominal pain, shortness of breath, 1 week low grade fever. Examination showed hepatosplenomegaly and right upper quadrant tenderness. CT showed retroperitoneal lymphadenopathy and innumerable liver masses, mediastinal lymphadenopathy and multiple subcutaneous nodules. Liver biopsy suspicious for PTLD but eventually shown to be melanoma.
Demonstration of imputability or root cause:
No history of melanoma in donor or recipient. DNA fingerprinting of short tandem repeats showed tumor to be of donor origin.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
case report
malignancy
melanoma
liver transplant
Reference attachment:
Suggest references:
Bilal M, Eason JD, Das K, Sylvestre PB, Dean AG, Vanatta JM. Donor-derived metastatic melanoma in a liver transplant recipient established by DNA fingerprinting. Exp Clin Transplant. 2013 Oct;11(5):458–63.
Note:
First review done 5/20/18 MN
Second review done 5/31/18 MCS
Expert comments for publication:
Patient treated with decreased immunosuppression, temozolomide and thalidomide with partial response; rejection episode resulted in switch from tacrolimus to sirolimus; later reduced. Patient re-presented 8 months after melanoma diagnosis with seizure and altered mental status, CT showed multiple CNS lesions. Whole brain radiation given with temporary improvement but patient died of CNS disease shortly thereafter. Authors note that elderly patients with idiopathic intracranial hemorrhage have highest risk of melanoma transmission.